Pulmonary edema in patients after liver transplantation

The aim of this study is to determine the incidence of radiological pulmona ry edema in elective liver transplant recipients and its relationship to pe rioperative factors and postoperative course. Me reviewed 102 chest radiogr aphs from 34 patients who had undergone orthotopic liver transplantation (O LT), Films were assessed by 2 trained radiologists for evidence of pulmonar y edema using a standardized system. Clinical and outcome data from the 34 patients were also recorded. There was a high incidence (47%) of postoperat ive radiological pulmonary edema that was associated with deterioration in gaseous exchange, elevated pulmonary artery pressure, and increased duratio n of ventilator dependence and intensive care stay. Eighteen percent of the patients developed edema immediately after surgery, which was associated w ith greater pulmonary artery pressure and transfusion requirements during s urgery, An additional 29% developed edema during the next 16 to 20 hours, b ut there was no association with fluid replacement. We conclude that pulmon ary edema is common after OLT and will influence postoperative recovery in a substantial proportion of transplant recipients. Excess perioperative flu id replacement is unlikely to be the sole mechanism of edema in these patie nts.